Individual
MRS. AMANDA KAY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1531 WEST MAIN, TISHOMINGO, OK 73460
(580) 371-8719
Mailing address
PO BOX 194, MILBURN, OK 73450-0194
(580) 371-8719
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/31/2011
Last updated
05/31/2011
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